Application for repayment deferment of special loans such as emergency small amount funds
under the Livelihood Welfare Fund Loan System

Guide to how to apply for repayment deferment

business loans (excluding mortgages)(5)

If, as a result of consultation with a self-

Opinion letter from the self-reliance support agency

opinion of the agency is that repayment(6)deferment is appropriate
If repayment is difficult for reasons otherthan (1) through (5)No documents need to be submitted* Please be sure to fill in the specific circumstancesthat make repayment difficult in the "Reason forApplication" section of the application form.

* You may also apply if you are in the process of applying for exemption.

2. How to apply
Those in categories (1) to (5) above: Fill in the necessary information on the application form on the right, cut
it along the dotted line, and mail it together with the required documents listed above.
Those in category (6) above: Fill in the necessary information on the application form on the right, cut it along
the dotted line, and mail only the application form.
* Please note that if the "Reason for Application" section is not filled in, it will be considered
incomplete and the review will take longer.

中央にキリ
トリ線表示) ―――――

reliance support consultation agency, the――――― (1. Cases where repayment deferment may be applied for and required documents
Cases where repayment deferment may beRequired documents
applied for(1) If you are affected by an earthquake or fire, Disaster Victim Certificate, or other documentation thatconfirms that you have been affected by the disasteretc.
(2) If you are receiving treatment for an illness Medical certificate, medical condition certificate, orother documentation that confirms that you arereceiving treatment for an illness(3) If you are involuntarily unemployed or
Certificate of retirement, release form, or otherseparated from employment
document that confirms that you are involuntarily
unemployed or separated from employment(4) If you are receiving repayment deferment on Documentation confirming that the applicant has been
granted repayment deferment for other loans
other loans, such as scholarships or

I have read and agree to all of the following items and hereby apply for repayment
deferment as follows.
ABC

If repayment deferment is approved, I agree to my personal information being
provided to a self-reliance support consultation agency for the purpose of utilizing
it in the performance of the organization's duties.
I agree to my personal information being provided to third parties to the extent
necessary for this program.
I agree that the Saitama Prefectural Council of Social Welfare may query municipal
councils of social welfare, self-reliance support consultation agencies, local
governments, and other related organizations to receive my personal information tothe extent necessary for this program.
//* Please be sure to sign yourname (the name writtenon the notification) in thebox on the left.

Borrower's NameTelephone Number

To the Chair of the Saitama Prefectural Council of Social Welfare
Reason forapplication(Tick the box ) (1) If you are affected by an earthquake or fire, etc.
 (2) If you are receiving treatment for an illness (3) If you are involuntarily unemployed or separated from employment
 (4) If you are receiving repayment deferment on other loans, such as scholarships or business loans(excluding mortgages)

 (5) If, as a result of consultation with a self-reliance support consultation agency, the opinion of the agency
is that repayment deferment is appropriate.

* If you checked any of (1) through (5), please enclose documents with which the circumstances of thechecked items can be confirmed.

3. Application deadline
If you wish to defer repayment from January 2025, please submit your application by Friday,
November 29, 2024 (postmarked).
* Applications submitted on or after December 17, 2024, will result in repayment deferment starting fromFebruary 2025, so you will need to make the repayment for January 2025.

 (6) Reasons other than (1) through (5) above* If you checked item (6), please describe the circumstances that make repayment difficult below.
Regarding living and income, etc. *Please provide as much detail as possible.

4. Results of review
You will be notified of the results in writing.* It takes about one to one and a half months from the application
to the sending out of the results.
* Please note that depending on the status of the review, those who are currently applying for repayment
forgiveness may also receive this notification.
5. Application for repayment forgiveness for Reasons Other than Inhabitants Tax Exemption
If you meet any of the following criteria after the repayment has started, you can apply for repayment
forgiveness separately. If you wish to apply, please contact the following contact for inquiries below.
･ Those receiving public assistance･ Those who have been issued a Mental Health and Welfare Handbook (Level 1) or the PhysicallyHandicapped Persons Handbook (Level 1 or 2)[Contact for Inquiries]
Saitama Prefectural Council of Social Welfare, Repayment and Exemption of COVID-19 Special Loan Section[Telephone Number] 050-2018-1839 [Reception Time] Weekdays 9:00-17:00 https://www.fukushi-saitama.or.jp/site/problem_33.html<Special loan name>

Type of fundDetails of loan

<Loan amount>

Amountborrowedyen

Loan Code<Fund code><Loan code>

Deferment
period* The repayment deferment period after the deferment listed below will vary depending on the timing of the application.

Repayment
period before
deferment

1 year<Repayment
fromStartDate><Final repayment date> toRepayment
period afterdeferment<Repayment start dateafter deferment> from
<Repayment deadline
after deferment> to